Characteristics Abortion Care Service Provision in Debre Markos, Ethiopia

Background:  Unsafe abortion is one of the top three causes of maternal deaths in Ethiopia.  In 2005, the Ethiopian government liberalized laws on abortion to address this problem. There is much to learn about how patients and providers have responded to this new access.  To that end, this study examines the characteristics of patients seeking abortion services and the types of care offered to them at a tertiary public facility in Ethiopia. 

Methodology: This retrospective study uses secondary data extracted from medical records for women requesting safe abortion services at the Debre Markos Referral Hospital, in the Amhara region for the year 2013.

Results: On average the women (N=415) were 27 years old. The majority sought care because of incomplete abortion (43%) or to terminate a pregnancy due to rape (34.7%).  Younger women were more likely than others to cite rape as the reason for seeking care (paired t-test p<0.001).  Most women presented in their first trimester.

The most common abortion procedures were manual vacuum aspiration (56.57%) and medical abortion (MA) (20%). Unexpectedly, MA was more common in women presenting later rather than earlier in pregnancy (OR=1.23 p<0.001). There were no fatalities and very few (<5%) complications among patients. Use of MA was associated with reduced likelihood of complications after controlling for risk factors.  Most women (80%) received both contraception and HIV counseling and the majority (63.83%) said they wanted contraception.

Implications: More intensive contraceptive counseling might be needed to increase uptake and further investigation into the reasons for the relatively low use of MA for the termination of early pregnancies is warranted.